| NPI | 1336490366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2780) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012266) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2014-12-06 |