| NPI | 1215378823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2669) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4948-12) |
| 111N00000X Chiropractor (Licence: KY 5385) | |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2020-05-04 |