| NPI | 1285350751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: WA CH61367019) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61367019) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2025-05-19 |