| NPI | 1730183070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IN 08001764A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001764A) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2010-11-10 |