| NPI | 1477695690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60070004) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004299-1) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2011-01-31 |