| NPI | 1184736837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002225) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08001257A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-03-25 |