| NPI | 1720837743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6342) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61514940) |
| 111N00000X Chiropractor (Licence: IL 038.014106) | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-13 |