| NPI | 1609044064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60133937) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00662700) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2012-11-07 |