| NPI | 1669421376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034737) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI KS8927) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-10-22 |