| NPI | 1417302688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60647753) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA - 1717) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2016-09-07 |