| NPI | 1780188920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIRO10031) |
| Additional Taxonomies | 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic (Licence: GA 4772) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-05-01 |