| NPI | 1518285147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 3965) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001466A) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2010-05-06 |