| NPI | 1467404772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002231A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5051) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: IN 08002231A) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-12-01 |