| NPI | 1275615304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00002998) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273017) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2018-10-10 |