| NPI | 1396085189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60516617) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012296) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2020-10-15 |