| NPI | 1326147075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIRO007991) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC006779L) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-30 |