| NPI | 1306139654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5291) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008809) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2011-05-19 |