| NPI | 1962046938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 285432) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4468) |
| Enumeration Date | 2019-11-03 |
| Last Update Date | 2025-08-11 |