| NPI | 1518006642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000000625) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 1902 012) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2011-08-17 |