| NPI | 1104313352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15408) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60833127) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2023-01-12 |