| NPI | 1003382326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 097525) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003059A) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2019-08-07 |