| NPI | 1770584575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08001207) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IN 08001207) |
| 111N00000X Chiropractor (Licence: KY 4046) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2008-07-03 |