| NPI | 1033072301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR066598) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR066598) |
| Enumeration Date | 2025-12-04 |
| Last Update Date | 2026-04-16 |