| NPI | 1366636169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 1791) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO07780) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2019-10-14 |