| NPI | 1093789042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 1996) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1569) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2026-06-29 |