| NPI | 1477735306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 2110) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: GA 2110) |
| 111NX0800X Chiropractor Orthopedic (Licence: GA 2110) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2010-10-05 |