| NPI | 1447582150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3235) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: OR 3235) |
| 111NR0400X (Licence: OR 3235) | |
| 111NI0900X Chiropractor, Internist (Licence: OR 3235) | |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2023-10-13 |