| NPI | 1235230954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR001771) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL LIC 0981-I) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-09 |