| NPI | 1871179960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: GA CHIR009817) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009817) |
| Enumeration Date | 2021-03-20 |
| Last Update Date | 2021-03-20 |