| NPI | 1194787127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 767) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3600) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2008-03-17 |