| NPI | 1730262460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: TN 1039) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0001039) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-11-18 |