| NPI | 1205990652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1637) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 65 1637) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-11-12 |