| NPI | 1205805975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 27 2622) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00003521) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2020-07-08 |