| NPI | 1255870119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2553-I) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2026-03-25 |