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 |