| NPI | 1851943641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 289222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557540) |
| Enumeration Date | 2019-07-11 |
| Last Update Date | 2024-01-16 |