| NPI | 1093007007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC2339) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009851) |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2012-01-30 |