| NPI | 1619519014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2021) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60727000) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-11-10 |