| NPI | 1003132408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 4013) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: OR 4013) |
| 111NN1001X Chiropractor Nutrition (Licence: OR 4013) | |
| 111NP0017X Chiropractor Pediatric Chiropractor (Licence: OR 4013) | |
| 111NR0200X Chiropractor Radiology (Licence: OR 4013) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: OR 4013) | |
| 111NS0005X Chiropractor Sports Physician (Licence: OR 4013) | |
| 111NX0800X Chiropractor Orthopedic (Licence: OR 4013) | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2010-04-12 |