| NPI | 1245431501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: AL 2213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2213) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2023-04-03 |