| NPI | 1659515476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60159579) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31234) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2014-11-05 |