| NPI | 1942285499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1036) |
| 111N00000X Chiropractor (Licence: IL 038-010377) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2009-08-27 |