| NPI | 1467508960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2712) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5027) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2022-07-21 |