| NPI | 1053640136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 60175383) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA MA 00016918) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2010-10-13 |