| NPI | 1922446665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5462) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4922-12) |
| 111N00000X Chiropractor (Licence: OH 4524) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2016-04-27 |