| NPI | 1760624134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc 31988) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA ch 60070657) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2012-03-14 |