| NPI | 1457325235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 27 2181) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 2042) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2011-01-25 |