| NPI | 1629465703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60636464) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33105) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2022-07-21 |