| NPI | 1215271234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08001711A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05005146A) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |