| NPI | 1356416184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 27 1917) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 879) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-07-10 |