| NPI | 1346791159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60651990) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND 1045) |
| 111N00000X Chiropractor (Licence: AZ 8510) | |
| 111N00000X Chiropractor (Licence: AZ 5123) | |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2019-11-22 |