| NPI | 1336466143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60150335) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH-60150335) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2012-03-29 |