| NPI | 1548301369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 3195) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2236) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2017-10-23 |