| NPI | 1588854897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2205) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 4867441-1202) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-06-08 |