| NPI | 1700921327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA ch00034792) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1134) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-02-11 |