| NPI | 1942077730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61480977) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC61482531) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-18 |