| NPI | 1598302267 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO10360) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH DC-04926) |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2020-05-12 |