| NPI | 1568737682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5314) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2020-01-10 |