| NPI | 1467595470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5040) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 2496756) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-04-07 |