| NPI | 1255613410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009342) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2343) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2014-08-20 |