| NPI | 1104926179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3682) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 713682) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2022-01-06 |