| NPI | 1225107675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 2558) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 5850) |
| 111N00000X Chiropractor (Licence: SC 2151) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-03-31 |