| NPI | 1275888380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6815) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009014) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2022-03-30 |