| NPI | 1043429616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 34081) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 28066) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2012-02-01 |