| NPI | 1285792929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: TN 2115) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TN 2115) |
| 111NT0100X Chiropractor, Thermography (Licence: TN 2115) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2009-08-22 |