| NPI | 1376066357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60758736) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012958) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2017-07-20 |