| NPI | 1659608032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 8714152-0162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60118223) |
| Enumeration Date | 2009-11-05 |
| Last Update Date | 2013-11-07 |