| NPI | 1750487583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 250751) |
| Additional Taxonomies | 111NI0900X Chiropractor Internist (Licence: KY 4384) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2023-09-22 |