| NPI | 1588795876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR004770) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301004794) |
| 225100000X Physical Therapist (Licence: GA PT003266) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2011-11-04 |