| NPI | 1467635631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2506) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009694) |
| 111N00000X Chiropractor (Licence: KY 5369) | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2012-11-13 |