| NPI | 1508911447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 1729) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: WA 1729) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2015-12-22 |