| NPI | 1154078947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010576) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR010576) |
| 111NR0400X (Licence: GA CHIR010576) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR010576) | |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-03-02 |