| NPI | 1295861144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008572) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8624) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2015-07-29 |