| NPI | 1972676351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 21044) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |