| NPI | 1750721700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 274317) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3746) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2022-01-05 |