| NPI | 1568577179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 3287) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 254) |
| 111N00000X Chiropractor (Licence: SC 2978) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-10-31 |