| NPI | 1710917570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 4976) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 1603) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-07-30 |