| NPI | 1053956599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 0000003317) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557422) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2020-10-26 |