| NPI | 1194159269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2214) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 4673) |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2013-08-26 |