| NPI | 1972661353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034303) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA ch34303) |
| 111N00000X Chiropractor (Licence: OR 273103) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2012-01-25 |