| NPI | 1497006506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60307542) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2012002509) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2012-09-28 |