| NPI | 1144844523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1968) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61168348) |
| 111N00000X Chiropractor (Licence: UT 11659095-1202) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: UT 116590951202) | |
| Enumeration Date | 2020-06-02 |
| Last Update Date | 2023-05-05 |