| NPI | 1558519223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5308) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010734) |
| 111N00000X Chiropractor (Licence: FL CH 11474) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2016-03-02 |