| NPI | 1992066385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 277969) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32157) |
| Enumeration Date | 2012-06-02 |
| Last Update Date | 2023-07-14 |