| NPI | 1306155361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008717) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: GA CHIR008717) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2014-04-24 |