| NPI | 1962620773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4620) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002426A) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-05-27 |