| NPI | 1336475854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4410) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60115571) |
| 111N00000X Chiropractor (Licence: SC 4414) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2021-03-20 |