| NPI | 1023152303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000000140) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 04557) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2007-07-08 |