| NPI | 1992866370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH00034037) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA00010481) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |