| NPI | 1740149780 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010470) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: GA CHIR010470) |
| Enumeration Date | 2026-01-16 |
| Last Update Date | 2026-01-16 |