| NPI | 1699842625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4622) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 17124) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-07-07 |