| NPI | 1336505825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 249124) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5486) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2021-04-28 |