| NPI | 1528172368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: TN DC1171) |
| Additional Taxonomies | 111NX0100X Chiropractor Occupational Health (Licence: TN DC1171) |
| 111NX0800X Chiropractor Orthopedic (Licence: TN DC1171) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2007-07-08 |