| NPI | 1598833634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR008718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 380) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: GA CHIR008718) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2013-04-17 |