| NPI | 1124579826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009652) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO09652) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2019-04-04 |