| NPI | 1558868810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5874) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC220283) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2026-06-01 |