| NPI | 1679123657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 252369) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003372A) |
| Enumeration Date | 2019-09-12 |
| Last Update Date | 2025-07-02 |