| NPI | 1477718344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: WA CH60011808) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60011808) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-06-01 |