| NPI | 1215389895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 294757) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13227) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2024-09-25 |