| NPI | 1023191129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4186) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA chir007791) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-01-26 |