| NPI | 1023396595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA ch60235745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1848) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2011-08-01 |