| NPI | 1851005151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003480A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 14352) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2025-01-10 |