| NPI | 1760718704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5248) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-011541) |
| 111N00000X Chiropractor (Licence: IN 08002825A) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2023-05-22 |