| NPI | 1679615678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00003031) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: WA 3606) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-04-27 |