| NPI | 1073988176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2704) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2024-05-28 |