| NPI | 1558822486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003127A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4318) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2019-11-11 |