| NPI | 1942207816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4703) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002246A) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2022-04-14 |