| NPI | 1942241096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000002203) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010621) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2010-09-29 |