| NPI | 1871238931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010908) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: OH DC-05163) |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2024-08-05 |