| NPI | 1174574743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034649) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038009378) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-09-21 |