| NPI | 1841593761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60183190) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4708-012) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2011-06-22 |