| NPI | 1679582233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2482) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 575) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2011-05-13 |