| NPI | 1275822074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2335) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2508) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-08-06 |