| NPI | 1528014297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 3248) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA1042) |
| 111N00000X Chiropractor (Licence: OR 3222) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2012-01-03 |