| NPI | 1093957961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5888) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR ac208234) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2025-11-12 |