| NPI | 1649324161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60423749) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00019867) |
| 225700000X Massage Therapist (Licence: WA MA00019867) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2014-12-09 |