| NPI | 1598112542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5537) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007442) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-10-06 |