| NPI | 1821560137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3152) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TN 3152) |
| 111NN1001X Chiropractor, Nutrition (Licence: TN 3152) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: TN 3152) | |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2018-12-27 |