| NPI | 1437665171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 6904) |
| Enumeration Date | 2017-12-18 |
| Last Update Date | 2025-07-09 |