| NPI | 1396978011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3870) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60040684) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2011-09-29 |