| NPI | 1407811680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249630) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4991) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2023-07-10 |