| NPI | 1326178294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: GA 2120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR0002120) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-04-07 |