| NPI | 1477653921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1963) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 0206594) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2011-10-04 |