| NPI | 1265648539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007922) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: GA 562) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2026-01-29 |