| NPI | 1770613580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 3554) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22433) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-01-12 |