| NPI | 1710176987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249746) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10754) |
| 111N00000X Chiropractor (Licence: KY 5163) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-11-24 |