| NPI | 1992228191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60775234) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8958) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2026-07-07 |