| NPI | 1639541485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009022) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR009022) |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR009022) | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2022-01-14 |