| NPI | 1356589238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO10109) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002415A) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2024-05-07 |