| NPI | 1255748968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR009340) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH11409) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2025-01-09 |