| NPI | 1558536581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008344) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 8344) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2020-10-30 |