| NPI | 1689771081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4806) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 1060) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-08-18 |