| NPI | 1205833969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3516) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 5644) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2024-07-26 |