| NPI | 1205074978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: KY 249326) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 249326) |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2020-01-29 |