| NPI | 1528046661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-810) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00003346) |
| 363LF0000X Nurse Practitioner Family (Licence: ID NP-1087A) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2013-06-26 |