| NPI | 1750439063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: WA 2916) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WA 2916) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2010-07-27 |