| NPI | 1659674521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60176125) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 4070) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2016-09-30 |