| NPI | 1104973601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA chiro09238) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001593) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2014-04-09 |