| NPI | 1295251957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009894) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0009042) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2026-04-16 |