| NPI | 1770639015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA 2476) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1480) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2007-07-08 |