| NPI | 1194885111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010432) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3595) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-10-23 |