| NPI | 1760789705 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: GA 007172) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 007172) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: GA 007172) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: GA 007172) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |