| NPI | 1205437977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61062221) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008181) |
| Enumeration Date | 2020-11-07 |
| Last Update Date | 2023-08-02 |