| NPI | 1124231600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0100X Chiropractor, Occupational Health (Licence: NC 4976) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR007941) |
| 111NX0100X Chiropractor, Occupational Health (Licence: SC 3776) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-07-28 |