| NPI | 1952493074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 508) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 3470) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-02-01 |