| NPI | 1134431679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007336) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5264) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2015-06-10 |