| NPI | 1861715211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: WA CH 60189008) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3991) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2015-11-05 |