| NPI | 1871957860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557936) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002898A) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-11-26 |