| NPI | 1154628865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8014253-1202) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH60205190) |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2019-10-25 |