| NPI | 1194127670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 9385) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3940) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2015-07-06 |