| NPI | 1639675796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60876066) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12456) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2019-07-19 |