| NPI | 1144278623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009528) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010690-1) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-04-11 |