| NPI | 1629111505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: GA CHIR006263) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR006263) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-09 |