| NPI | 1497827083 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007940) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3137) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |