| NPI | 1528145125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MS 516) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 1422) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-06-05 |