| NPI | 1124379094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009598) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2370) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2021-04-08 |