| NPI | 1114231172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: WA CH 60161920) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60161920) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WA CH 60161920) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2011-02-21 |