| NPI | 1174724462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60235375) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5585) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2016-07-29 |