| NPI | 1588786743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4051) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: KY 4051) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2013-08-16 |