| NPI | 1720450950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002889A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8507) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2023-05-05 |