| NPI | 1407166929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5256) |
| Additional Taxonomies | 111NR0400X (Licence: KY 5256) |
| 111NS0005X Chiropractor, Sports Physician (Licence: KY 5256) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2010-10-18 |