| NPI | 1992874721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: TN 677) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: TN 677) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2014-09-30 |