| NPI | 1083612923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 715) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1098) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2007-07-09 |