| NPI | 1780758466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00002227) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006668) |
| 111N00000X Chiropractor (Licence: WI 2305-012) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-09 |