| NPI | 1770569923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034846) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3047) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2021-12-08 |