| NPI | 1013900372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00001479) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH00001479) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH00001479) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2016-02-24 |