| NPI | 1962045724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2021009678) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003124A) |
| 111N00000X Chiropractor (Licence: IL 038.013544) | |
| 111NN1001X Chiropractor, Nutrition (Licence: IN 08003124A) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: IN 08003124A) | |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2021-08-11 |