| NPI | 1912175530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR002902) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 2902) |
| Enumeration Date | 2008-02-17 |
| Last Update Date | 2021-04-08 |