| NPI | 1225235799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 1514) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 2646) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2012-11-27 |