| NPI | 1699118919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1913) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 009431) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2017-03-01 |