| NPI | 1467717181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TN 2562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2562) |
| 111NI0900X Chiropractor Internist (Licence: TN 2562) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: TN 2562) | |
| Enumeration Date | 2012-07-09 |
| Last Update Date | 2023-09-20 |