| NPI | 1992839252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 1135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 1944) |
| 111N00000X Chiropractor (Licence: CA 12101) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2007-07-08 |