| NPI | 1518971308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007051) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 7051) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-12-11 |