| NPI | 1235666579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2217) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60758878) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2022-02-15 |