| NPI | 1225909567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003578A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.014359) |
| Enumeration Date | 2025-09-17 |
| Last Update Date | 2026-06-17 |