| NPI | 1033857644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003334A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2022017413) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2023-08-17 |