| NPI | 1255862207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009849) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR009849) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2019-11-19 |