| NPI | 1689879520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3487) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5057) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2012-08-16 |