| NPI | 1003231069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60424734) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009114) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2014-02-27 |