| NPI | 1629155684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 2046) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 1928) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |