| NPI | 1902572118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: GA CHIR010551) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010551) |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR010551) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: GA CHIR010551) | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-18 |