| NPI | 1114199676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60002301) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01193) |
| Enumeration Date | 2008-03-25 |
| Last Update Date | 2014-10-21 |