| NPI | 1972602548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034618) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1464) |
| 111N00000X Chiropractor (Licence: CO 5690) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-01-16 |