| NPI | 1487952933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002805A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5281) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2014-12-10 |