| NPI | 1497833636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: WI 3825-012) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WI 3825-012) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-09-02 |