| NPI | 1508449034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR066503) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 269683) |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2025-07-08 |