| NPI | 1194802801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA 60289583) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MA 2521) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-10-01 |