| NPI | 1780816389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH-60130771) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1380) |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2016-12-15 |