| NPI | 1356957054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 61483660) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA 61483558) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2024-03-13 |