| NPI | 1629799291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3699) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010441) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-02-22 |