| NPI | 1871500470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 504) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN DC0000504) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2016-04-15 |