| NPI | 1700203585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60654697) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12530) |
| 111N00000X Chiropractor (Licence: ID 5161471) | |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2025-02-08 |