| NPI | 1962694703 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA Chiro11064) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 06953) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2025-02-16 |