| NPI | 1801442561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010205) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6634) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2019-08-16 |