| NPI | 1760622864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4134) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008445) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2011-05-02 |