| NPI | 1760895031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5564) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60468027) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2026-04-22 |