| NPI | 1487607164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA 1558) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: WA 1558) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-11-22 |