| NPI | 1548647886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009568) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557253) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2016-11-29 |