| NPI | 1013248780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60133585) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 4078) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2015-09-04 |