| NPI | 1992756993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 5029) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10314) |
| Enumeration Date | 2006-05-14 |
| Last Update Date | 2016-05-09 |