| NPI | 1437358082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 17087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08160) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2025-04-08 |