| NPI | 1780713388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60506510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 5549) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2014-12-31 |