| NPI | 1578744512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1238) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 1662) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2007-11-19 |