| NPI | 1700265253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2537) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009618) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-03-17 |