| NPI | 1053411041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 272916) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OR 272916) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2013-11-01 |