| NPI | 1487909602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60647247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32365) |
| Enumeration Date | 2012-07-14 |
| Last Update Date | 2018-09-24 |