| NPI | 1669431458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034749) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038010545) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-12-12 |