| NPI | 1013090067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: OR 273434) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3434) |
| 111NR0400X (Licence: WA 60127216) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-08-18 |