| NPI | 1316017031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 0000003207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010418-1) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2021-11-19 |