| NPI | 1992361158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor Independent Medical Examiner (Licence: IN 08003166A) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: MO 2019015447) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-11-03 |