| NPI | 1720172794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 34020) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 283282) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-06-17 |