| NPI | 1851798292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 205570) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4345) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2021-11-24 |