| NPI | 1861685695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR002370) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIRO02370) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |