| NPI | 1477794436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3811) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: OR 3811) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 3811) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: OR 3811) | |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2018-09-11 |