| NPI | 1760422851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05034) |
| 111N00000X Chiropractor (Licence: OK 3499) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2008-03-24 |