| NPI | 1093043259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60127381) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI CH60127381) |
| Enumeration Date | 2009-11-30 |
| Last Update Date | 2015-04-24 |