| NPI | 1790875508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OK 4398) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034408) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2022-04-12 |