| NPI | 1184768053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1630) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 271630) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2012-05-18 |