| NPI | 1497812267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4785) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: KY 4785) |
| 111NR0200X Chiropractor, Radiology (Licence: KY 4785) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: KY 4785) | |
| 111NR0400X (Licence: KY 4785) | |
| 171M00000X Case Manager/Care Coordinator (Licence: KY 4785) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2015-01-12 |