| NPI | 1750714234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009166) |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2014-01-06 |