| NPI | 1316001985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO005857) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: GA 005857) |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA 005857) | |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2016-08-23 |