| NPI | 1851485775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009736) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA CHIR009736) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2025-09-29 |