| NPI | 1205899390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00033789) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2019-12-10 |