| NPI | 1639274665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60020406) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1198) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-10-29 |