| NPI | 1770953085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6307) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60610067) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2023-06-07 |