| NPI | 1407119605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 4017) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OR OR4017) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2021-08-04 |