| NPI | 1962434142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD00038676) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034708) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-03-24 |