| NPI | 1467929968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003190A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5944) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2021-03-31 |