| NPI | 1851800635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4280) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009857) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-07-21 |