| NPI | 1992801922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034770) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 925) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-01-30 |