| NPI | 1992006035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH60314301) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4122) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2018-09-11 |