| NPI | 1174741862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60667861) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5515) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2019-12-26 |