| NPI | 1316975634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003200A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC19367) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-03-30 |