| NPI | 1376514638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR005305) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007847) |
| 111N00000X Chiropractor (Licence: NC 2134) | |
| 111N00000X Chiropractor (Licence: SC 1905) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2014-10-29 |