| NPI | 1821339375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 1289) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: GA 1289) |
| 111NX0800X Chiropractor, Orthopedic (Licence: GA 1289) | |
| Enumeration Date | 2013-03-08 |
| Last Update Date | 2013-03-08 |