| NPI | 1659452738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 288936) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: IN 08002033A) |
| 111NR0400X (Licence: IN 08002033A) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2024-02-06 |