| NPI | 1689236770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: WA CH60900872) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60900872) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2025-01-14 |