| NPI | 1588760367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA Chiro08401) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3178) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2009-02-09 |