| NPI | 1316215593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH 60271312) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 32019) |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2017-11-10 |