| NPI | 1992799142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 6067) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2007-07-08 |