| NPI | 1588419535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 1345) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3517) |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-06-25 |