| NPI | 1275636375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2884) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1920) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2022-10-06 |