| NPI | 1417364035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2519) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 9069) |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2017-03-30 |