| NPI | 1184692014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002098) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2098) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-02-22 |