| NPI | 1003473950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003468A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2018015902) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-03-20 |