| NPI | 1841439304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009034) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT001496) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2012-08-15 |