| NPI | 1194809103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008202) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: GA CHIR008202) |
| 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR008202) | |
| 111NR0400X (Licence: GA CHIR008202) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR008202) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR008202) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2019-09-13 |