| NPI | 1447673983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHI 1584) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA Ch60742216) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2017-05-06 |