| NPI | 1558495093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034761) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 6445521-1202) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-07-24 |