| NPI | 1235350802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 9110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1077) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-10-10 |