| NPI | 1336357250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA 006460) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 100204) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2014-09-23 |