| NPI | 1356584734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3881) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60047062) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2011-11-01 |