| NPI | 1821205337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2009001038) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00033961) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2009-07-23 |