| NPI | 1063572071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3399) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: TN 3399) |
| 111NR0200X Chiropractor Radiology (Licence: TN 3399) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: TN 3399) | |
| 111NS0005X Chiropractor Sports Physician (Licence: TN 3399) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2023-09-07 |