| NPI | 1699383935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010389) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1903) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2020-07-22 |