| NPI | 1336747989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010435) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO10435) |
| Enumeration Date | 2020-10-15 |
| Last Update Date | 2020-10-16 |