| NPI | 1083826986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60069981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4903) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2009-10-01 |