| NPI | 1326687021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61265752) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013312) |
| Enumeration Date | 2019-12-27 |
| Last Update Date | 2023-02-08 |