| NPI | 1255602819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 0000003312) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011992) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2021-12-28 |