| NPI | 1083209753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 12192559-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61221873) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2026-07-30 |