| NPI | 1740264142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11917) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60119619) |
| 111N00000X Chiropractor (Licence: OR 273269) | |
| 111N00000X Chiropractor (Licence: ID CHIA 1275) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2022-07-21 |