| NPI | 1871985937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61006230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012541) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2022-03-18 |