| NPI | 1194716886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO11160) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2937) |
| 111N00000X Chiropractor (Licence: IN 08003232A) | |
| 111N00000X Chiropractor (Licence: KY 267442) | |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2024-04-16 |