| NPI | 1295708030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3630) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2023-02-17 |