| NPI | 1861935173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-4595) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60706123) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2022-07-21 |