| NPI | 1639565021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009581) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3998) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2016-05-17 |