| NPI | 1083791057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00002853) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 600.216.479) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-02-25 |