| NPI | 1962198952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2352) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CHIR.CH.61413649) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2026-07-02 |