| NPI | 1205183175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002723A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2620) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2014-10-08 |