| NPI | 1053716035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15151) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60515175) |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2022-04-20 |