| NPI | 1003574013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61690390) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC36169) |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2026-04-03 |