| NPI | 1477585537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 868) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO08035) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-08-01 |