| NPI | 1366758716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 0000002486) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5241) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2020-01-13 |