| NPI | 1972551265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007009) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH00034599) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2013-01-25 |