| NPI | 1346289998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60153099) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038-009854) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2015-04-03 |