| NPI | 1396818324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH00002066) |
| Additional Taxonomies | 111NR0400X (Licence: WA CH00002066) |
| 111NX0800X Chiropractor, Orthopedic (Licence: WA CH00002066) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2014-06-05 |