| NPI | 1659323400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00002753) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5754) |
| 111N00000X Chiropractor (Licence: OR 272823) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2012-10-02 |