| NPI | 1225335201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2502) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2011004466) |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2025-09-09 |