| NPI | 1538121132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5339) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2708) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2018-10-03 |