| NPI | 1518201789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2624) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008763) |
| Enumeration Date | 2012-11-12 |
| Last Update Date | 2012-11-12 |