| NPI | 1417229048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 60440315) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5011) |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2016-07-07 |