| NPI | 1558174565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR011302) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2827) |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2025-01-31 |