| NPI | 1093051096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 075589) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002689A) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2015-05-29 |