| NPI | 1336197318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2231) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2269) |
| 247200000X Technician, Other | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2013-05-24 |