| NPI | 1356866115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249198) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-04734) |
| 111N00000X Chiropractor (Licence: KY 5557) | |
| Enumeration Date | 2017-08-13 |
| Last Update Date | 2021-05-06 |