| NPI | 1316184492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60326743) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3852) |
| Enumeration Date | 2009-01-12 |
| Last Update Date | 2013-05-05 |