| NPI | 1972541985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 249068) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002140A) |
| 111N00000X Chiropractor (Licence: KY 4847) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2023-04-18 |