| NPI | 1992721534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 428362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4504) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2021-05-14 |