| NPI | 1659439636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 2142) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: OR 27 2142) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2025-04-21 |