| NPI | 1063866895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1928) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA ch 60636706) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2019-11-19 |