| NPI | 1609015247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60066715) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH6006715) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2018-03-15 |