| NPI | 1629297627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR006015) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2882) |
| 111N00000X Chiropractor (Licence: IN 08001873A) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |