| NPI | 1770718330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR002929) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR002929) |
| 111NR0400X (Licence: GA CHIR002929) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2021-01-20 |