| NPI | 1740694843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60794073) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11238) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2024-09-04 |