| NPI | 1245351469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60555927) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NM 687) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2021-12-08 |