| NPI | 1124861919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH61683137) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 36975) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2025-06-23 |