| NPI | 1295030559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2470) |
| Additional Taxonomies | 111NR0400X (Licence: TN 2470) |
| 111NS0005X Chiropractor, Sports Physician (Licence: TN 2470) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2011-03-18 |