| NPI | 1558354084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 250032) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 9819) |
| 111N00000X Chiropractor (Licence: OH 2916) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-07-19 |