| NPI | 1316017312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5688) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00002538) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2016-02-11 |