| NPI | 1922100395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 2313) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3508) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2008-12-30 |