| NPI | 1871239327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000003398) |
| Additional Taxonomies | 111NR0400X (Licence: TN DC0000003398) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-05-09 |