| NPI | 1881733129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000000806) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 806) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2009-07-24 |