| NPI | 1386932275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR008841) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1951) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2012-03-09 |