| NPI | 1316114010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2497) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: GA 5021) |
| 111NR0400X Chiropractor Rehabilitation (Licence: GA 5021) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2011-05-05 |