| NPI | 1093012999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: OR 4064) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CHIR.CH.60226450) |
| 111N00000X Chiropractor (Licence: OR 4064) | |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2018-03-17 |