| NPI | 1265441133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08000911A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3927) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2015-03-31 |