| NPI | 1508328246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61143868) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038013216) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2021-02-09 |