| NPI | 1174736185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00001662) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: WA Ch00001662) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |