| NPI | 1962419812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH2714) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: WA Ch2714) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2008-07-16 |