| NPI | 1043465628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3847) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH 60126824) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2014-03-25 |