| NPI | 1063503969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 27203) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-07-21 |