| NPI | 1720373087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3636) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2019-06-15 |