| NPI | 1639318470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 11221) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60075858) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2013-07-09 |