| NPI | 1083133383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 5171646) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60784235) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2025-02-12 |