| NPI | 1588094817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 15130) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60418787) |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2024-04-03 |