| NPI | 1366876195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5490) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OR 5490) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: OR 5490) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 5490) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: OR 5490) | |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2023-10-26 |