| NPI | 1891236139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CH10421) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1310) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2020-09-24 |