| NPI | 1417283391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR008570) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: GA CHIR008570) |
| 111NN0400X Chiropractor, Neurology (Licence: GA CHIR008570) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR008570) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR008570) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2020-11-20 |