| NPI | 1215011630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002400A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556166) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-11-26 |