| NPI | 1871760751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002512A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10798) |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2011-11-15 |