| NPI | 1679980171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 60610717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60610717) |
| 111N00000X Chiropractor (Licence: OR 5574) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2015-12-18 |