| NPI | 1376861443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002765A.) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5309) |
| 111N00000X Chiropractor (Licence: TX 11403) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2017-08-16 |