| NPI | 1720084338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 1875) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR004818) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2017-01-18 |