| NPI | 1225536279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60883035) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 19927) |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2018-09-26 |