| NPI | 1780045021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 1048) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009417) |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2024-06-06 |