| NPI | 1659646412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: WA CH61625121) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: TX 11749) |
| Enumeration Date | 2012-03-13 |
| Last Update Date | 2025-04-03 |