| NPI | 1689685893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 1192) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 008172) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-09-08 |