| NPI | 1134111438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC 528) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 6057) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-02-21 |