| NPI | 1952364556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000001987) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3785) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2019-06-24 |