| NPI | 1134409386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 0000002900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5297) |
| 111N00000X Chiropractor (Licence: CO CHR 0007040) | |
| 111N00000X Chiropractor (Licence: GA chir009783) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2017-10-24 |