| NPI | 1326295817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3878) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 60026121) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2010-12-29 |