| NPI | 1972903599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3887) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR005027) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2014-09-02 |