| NPI | 1376783795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009837) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556650) |
| 111N00000X Chiropractor (Licence: OH DC4353) | |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2022-07-21 |