| NPI | 1558383612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 731) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 731) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-05-25 |