| NPI | 1770646838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1426) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR007946) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-03-05 |