| NPI | 1831126960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60424718) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8091) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2015-10-19 |