| NPI | 1922370469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60822653) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60143913) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2019-03-04 |