| NPI | 1316967136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: KY 4129) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4129) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2021-02-08 |