| NPI | 1740507805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60193083) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7617181-1202) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2020-01-28 |