| NPI | 1407145659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002717) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TN 9843) |
| 111N00000X Chiropractor (Licence: GA Chir008788) | |
| 225700000X Massage Therapist (Licence: GA MT003645) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2014-09-23 |