| NPI | 1003689415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI DC-1643) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 123224) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2025-12-05 |