| NPI | 1215785704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 294808) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3809) |
| Enumeration Date | 2024-05-09 |
| Last Update Date | 2024-10-16 |