| NPI | 1871032979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5106) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009717) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-01-18 |