| NPI | 1689794562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: GA CHIR008036) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR008036) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |