| NPI | 1346662350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5532) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC217825) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2026-05-08 |