| NPI | 1578807368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 005676) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 5676) |
| Enumeration Date | 2012-11-16 |
| Last Update Date | 2018-07-21 |