| NPI | 1477521169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4058) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002116A) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-06-20 |