| NPI | 1043342298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002201) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MS 1012) |
| 171100000X Acupuncturist (Licence: TN DC 2201) | |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2012-12-10 |