| NPI | 1487634259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2338) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1407) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2011-06-09 |