| NPI | 1154418929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2020) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA Ch00033952) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-10 |