| NPI | 1780929802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: WA CH60844340) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5088) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2023-01-20 |