| NPI | 1083615553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC336) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 845) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-05-21 |