| NPI | 1083761886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4022) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001891A) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2015-04-24 |