| NPI | 1457664732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1890) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: OR 1890) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |