| NPI | 1164740916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002790A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5265) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2021-05-17 |