| NPI | 1255779716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH60345251) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60345251) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-01-13 |