| NPI | 1679850549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH6023328) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60233228) |
| Enumeration Date | 2011-11-07 |
| Last Update Date | 2014-02-17 |