| NPI | 1760521553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 273134) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00003610) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-08 |