| NPI | 1912144452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60927781) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30644) |
| Enumeration Date | 2009-01-20 |
| Last Update Date | 2020-03-17 |