| NPI | 1629237516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104556615) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034101) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2010-09-20 |