| NPI | 1750979274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61124621) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH61124621) |
| 111NN1001X Chiropractor, Nutrition (Licence: WA CH61124621) | |
| 111NR0200X Chiropractor, Radiology (Licence: WA CH61124621) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH61124621) | |
| Enumeration Date | 2021-01-10 |
| Last Update Date | 2021-01-10 |