| NPI | 1396982070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2341) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556655) |
| Enumeration Date | 2009-01-16 |
| Last Update Date | 2012-08-01 |