| NPI | 1609190370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008601) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4607-12) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2013-11-11 |