| NPI | 1093144768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009448) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2022-08-06 |