| NPI | 1568584100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 0314) |
| 111NR0400X (Licence: CO 5473) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2019-08-14 |