| NPI | 1912093477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00002575) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 2575) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-03-08 |