| NPI | 1851434476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: GA 2148) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: FL 4508) |
| 111NX0800X Chiropractor, Orthopedic (Licence: WI 3452-012) | |
| 156FX1800X Technician/Technologist, Optician (Licence: GA 645) | |
| 156FX1800X Technician/Technologist, Optician (Licence: FL 875) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-08 |