| NPI | 1174901490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5631) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: OR 5631) |
| 111NR0400X Chiropractor Rehabilitation (Licence: OR 5631) | |
| 111NX0100X Chiropractor Occupational Health (Licence: OR 5631) | |
| 111NX0800X Chiropractor Orthopedic (Licence: OR 5631) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |