| NPI | 1336947662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61641478) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6438) |
| Enumeration Date | 2025-03-04 |
| Last Update Date | 2025-03-04 |