| NPI | 1417141060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60048137) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7849) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2012-03-08 |