| NPI | 1164687398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5284-KY) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001760) |
| 111N00000X Chiropractor (Licence: KY 5284) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-04-28 |