| NPI | 1295020725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: WA CH 60485899) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32130) |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2015-01-02 |