| NPI | 1013075787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN TN1191) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS MS0827) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |