| NPI | 1265508931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR008251) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27371) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2009-11-18 |