| NPI | 1194795682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 248960) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 14207) |
| 111N00000X Chiropractor (Licence: IN 08003175A) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-10-13 |