| NPI | 1275553992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000001289) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001545) |
| 111N00000X Chiropractor (Licence: GA 005611) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-06-26 |