| NPI | 1164981551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60937298) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2020-08-28 |