| NPI | 1245558550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16288) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60540141) |
| 111N00000X Chiropractor (Licence: AZ 8123) | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2023-12-05 |