| NPI | 1942548623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009058) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2962) |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2016-07-20 |