| NPI | 1558754812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4023) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009464) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |