| NPI | 1992830053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 250739) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 4368) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-12-02 |