| NPI | 1376074963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5809) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60723055) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2017-03-24 |