| NPI | 1265457758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor, Occupational Health (Licence: TX 9002) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: AZ 3772) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2012-02-17 |