| NPI | 1205002573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5120) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2020-11-17 |