| NPI | 1538321161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 3028) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW005625) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2017-04-13 |