| NPI | 1518236009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008723) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1883) |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2016-12-07 |