| NPI | 1639390594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: WA ch00033863) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WA ch00033863) |
| 111NT0100X Chiropractor, Thermography (Licence: WA ch00033863) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2007-08-13 |