| NPI | 1871250472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PR 000755) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2025-07-16 |