| NPI | 1386153047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003243A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6409) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2025-04-22 |