| NPI | 1710986518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1525) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001783A) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2020-08-06 |