| NPI | 1205978871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008771) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010687) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-03-07 |