| NPI | 1003447418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7785070-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO10232) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2023-12-13 |