| NPI | 1427245984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008162) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR008162) |
| 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR008162) | |
| 111NR0400X (Licence: GA CHIR008162) | |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2011-06-21 |