| NPI | 1932630837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10224169-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60721616) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-04-18 |