| NPI | 1558533737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007701) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3301) |
| Enumeration Date | 2008-03-28 |
| Last Update Date | 2008-03-28 |