| NPI | 1639104789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08002095) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO05965) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-09-12 |