| NPI | 1629395256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3576) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008651) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2016-08-13 |