| NPI | 1225879547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2358) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CHIR.CH.61553595) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2024-06-03 |