| NPI | 1629035571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA choooo3570) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA ch00003570) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2023-09-11 |