| NPI | 1083666739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: GA 2913) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: GA Ga2913) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-11-28 |