| NPI | 1821564543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO10132) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR010132) |
| Enumeration Date | 2018-10-20 |
| Last Update Date | 2022-09-16 |