| NPI | 1154577153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6066) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 34361) |
| 225700000X Massage Therapist (Licence: OR 14893) | |
| 225700000X Massage Therapist (Licence: CA 61333) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2024-04-23 |