| NPI | 1679667018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008287) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-04972) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-08-21 |