| NPI | 1235196114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 250318) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4033) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2020-05-04 |