| NPI | 1871812362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002525A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4011) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2010-11-30 |