| NPI | 1124416599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: GA CHIR009377) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: FL CH11740) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2016-10-20 |