| NPI | 1417179607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034743) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 23980) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2013-12-03 |