| NPI | 1235204850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR006909) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR005898) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-08 |