| NPI | 1457553547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY CH4879) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2377) |
| 111N00000X Chiropractor (Licence: GA CHIR006726) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2018-11-26 |