| NPI | 1790223337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID TCHI-2041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60697756) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2020-12-01 |