| NPI | 1710104989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: TN 2182) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: TN 2182) |
| 111NX0100X Chiropractor, Occupational Health (Licence: TN 2182) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2021-04-14 |