| NPI | 1306179130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008548) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2476) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2010-11-10 |