| NPI | 1003185810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2652) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC32149) |
| Enumeration Date | 2011-12-22 |
| Last Update Date | 2013-08-14 |