| NPI | 1700176252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61475607) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5543) |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2024-03-22 |