| NPI | 1104381011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61178701) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011422) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2021-07-06 |