| NPI | 1992046684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 5189440-1202) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: KY 5408) |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2017-12-06 |