| NPI | 1083665756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3328) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273328) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2012-07-11 |