| NPI | 1578595716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: TN MT-163458 (ASCP)) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000000721) |
| 111N00000X Chiropractor (Licence: NC 1808) | |
| 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: TN ML0000013693) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2025-09-11 |