| NPI | 1134172240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2915) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 640) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-06-13 |