| NPI | 1912051145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00003356) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 813CHI) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2013-02-27 |