| NPI | 1336251040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 2104) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 17697) |
| 111N00000X Chiropractor (Licence: CO 3949) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-10-15 |