| NPI | 1588710800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034659) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011339-1) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2012-04-26 |