| NPI | 1609968544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 3776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001343) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2012-10-30 |