| NPI | 1710958129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000000814) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TN MT0000004004) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2007-07-08 |