| NPI | 1942237102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60503164) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3792-012) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2014-11-24 |