| NPI | 1609071018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60169609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5996) |
| 175F00000X Naturopath (Licence: OR 4142) | |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2021-03-01 |