| NPI | 1356427033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5347) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 080002252A) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2012-08-08 |