| NPI | 1588977219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002585A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8159) |
| Enumeration Date | 2010-07-22 |
| Last Update Date | 2016-04-04 |