| NPI | 1700101953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO08747) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1231) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2010-11-23 |