| NPI | 1730107905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4407) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4272) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2024-01-31 |