| NPI | 1063417186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00003457) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR OR27136) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-06-25 |