| NPI | 1780270678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: GA CHIR010456) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010456) |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2021-04-07 |