| NPI | 1902005861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249695) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5058) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2023-09-26 |