| NPI | 1083786107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR005108) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA Chiro05108) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-11-20 |