| NPI | 1336890037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NC 5354) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5354) |
| 111N00000X Chiropractor (Licence: WA 61243039) | |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2022-08-05 |