| NPI | 1255348603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 1565) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 828) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2011-11-30 |