| NPI | 1427588151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60747255) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC33895) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2017-06-14 |