| NPI | 1427452960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 6178) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60501482) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2020-08-07 |