| NPI | 1023081155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6485) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60741817) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2026-06-24 |