| NPI | 1710350806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 60540142) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: WA CH 60540142) |
| 111NR0400X Chiropractor Rehabilitation (Licence: WA CH 60540142) | |
| 111NS0005X Chiropractor Sports Physician (Licence: WA CH 60540142) | |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |