| NPI | 1467520783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4056) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20358) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2014-03-11 |