| NPI | 1376651950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 287585-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08351) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2024-01-23 |