| NPI | 1023145547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN dc0000001769) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1769) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-10-13 |