| NPI | 1972909240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: OR 5964) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60511050) |
| Enumeration Date | 2014-11-13 |
| Last Update Date | 2020-10-27 |