| NPI | 1861674418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2316) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007029226) |
| 111N00000X Chiropractor (Licence: AR 16062) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2014-04-09 |