| NPI | 1578649620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: KY 50566100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 248917) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2024-10-08 |