| NPI | 1902923832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7812) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TN DC581) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2008-12-15 |