| NPI | 1598763278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000001905) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC00000001905) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-05-25 |