| NPI | 1902945009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH 00034771) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 28092) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2012-11-15 |