| NPI | 1265579957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 008148) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2660) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2020-08-28 |