| NPI | 1487151650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5910) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60832263) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-10-04 |