| NPI | 1396739728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4834) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556449) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2013-10-24 |