| NPI | 1376629717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 6200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 1512) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2007-11-17 |