| NPI | 1487912291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 60275801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5048) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2024-06-07 |