| NPI | 1558356634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60210207) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC008847) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2011-04-25 |