| NPI | 1083919245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4185) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 008477) |
| Enumeration Date | 2011-01-20 |
| Last Update Date | 2012-12-18 |