| NPI | 1477824134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5357) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002629A) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2014-03-14 |