| NPI | 1508006537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3867) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60043825) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2012-08-14 |