| NPI | 1679676605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4523) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: KY 250119) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2025-05-07 |