| NPI | 1184659013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00001351) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 1557) |
| 111N00000X Chiropractor (Licence: ID C-510) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-08-03 |