| NPI | 1730458126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5315) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 249456) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2021-03-10 |