| NPI | 1174739486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00003253) |
| Additional Taxonomies | 171W00000X Contractor (Licence: WA MA00003511) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-04-04 |