| NPI | 1396375242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 264594) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003139A) |
| Enumeration Date | 2020-01-20 |
| Last Update Date | 2021-08-11 |