| NPI | 1366847113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60719314) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 9178910-1202) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2023-08-22 |