| NPI | 1134403256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 1190876-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5307) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2022-05-16 |