| NPI | 1013297217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6699) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2024-07-25 |