| NPI | 1265624357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3266) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2283) |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2017-05-24 |