| NPI | 1336156298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: KY 3824) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3824) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-06-18 |