| NPI | 1861985236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 61074778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34239) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2024-02-05 |