| NPI | 1558723593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 636) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2908) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2018-07-19 |