| NPI | 1013040419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 2992) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19485) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-11-04 |