| NPI | 1588058762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249094) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5457) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2021-05-10 |