| NPI | 1225476278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60496961) |
| 111N00000X Chiropractor (Licence: MN 5809) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2021-03-04 |