| NPI | 1417136797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: GA CHIR006625) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: GA CHIRO006625) |
| 111NS0005X Chiropractor Sports Physician (Licence: GA CHIRO006625) | |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2017-06-08 |