| NPI | 1730145996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5062) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007703) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-03-21 |