| NPI | 1386917466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5313) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4812-12) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2012-02-20 |