| NPI | 1154684298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009002) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 518) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2013-09-27 |