| NPI | 1215127618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5177) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1699) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2015-02-18 |