| NPI | 1316253107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR010363) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA PTA002699) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2020-05-21 |