| 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 |