| NPI | 1003958331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4764) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2623) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2013-10-16 |