| NPI | 1285048124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 100318) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 100820) |
| 111N00000X Chiropractor (Licence: WA CH60467906) | |
| 111NN1001X Chiropractor, Nutrition (Licence: WA CH60467906) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-09-13 |