| NPI | 1306024237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 5585) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR005585) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2016-11-22 |