| NPI | 1679945273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61512334) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60569982) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2024-05-22 |