| NPI | 1013003771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 290033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000001562) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2024-07-17 |