| NPI | 1225719990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 61299967) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4421) |
| Enumeration Date | 2023-07-26 |
| Last Update Date | 2023-07-26 |