| NPI | 1245535236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 60171316) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31691) |
| Enumeration Date | 2011-01-21 |
| Last Update Date | 2021-08-09 |