| NPI | 1588853261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 5155) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2578) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2010-10-21 |