| NPI | 1720335466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002794) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4329) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2015-02-10 |