| NPI | 1053621961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR008590) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008590) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2010-10-13 |