| NPI | 1912187188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: GA CHIR005054) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: GA CHIR005054) |
| 111NS0005X Chiropractor, Sports Physician (Licence: GA CHIR005054) | |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |