| NPI | 1669929568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010307) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4675) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2024-08-27 |