| NPI | 1154669307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO010067) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557046) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2020-09-04 |