| NPI | 1235415399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008917) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4040) |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2013-01-03 |