| NPI | 1538261284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008544) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS KS-4071) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-07-29 |