| NPI | 1124335070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5621) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60168065) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2021-09-13 |