| NPI | 1497310924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6341) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 25064) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-02-03 |