| NPI | 1609820349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC260) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 4022) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-08-29 |