| NPI | 1205235587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60512388) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 009373) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2018-07-10 |