| NPI | 1457390635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2810) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06812) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-07-17 |