| NPI | 1760539134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: TN 778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 778) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2012-10-10 |