| NPI | 1306011028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60002296) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30752) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2008-04-23 |