| NPI | 1508545104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO10945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC-1587) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2024-01-14 |