| NPI | 1487892063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249312) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5173) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2025-08-29 |