| NPI | 1912908286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007628) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 812) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2012-09-20 |