| NPI | 1689949554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010561) |
| Additional Taxonomies | 173C00000X Reflexologist (Licence: GA MT006503) |
| 225700000X Massage Therapist (Licence: GA MT006503) | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2022-08-04 |