| NPI | 1518919851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 27 3470) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: OR 3470) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2021-03-22 |