| NPI | 1689381451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: OR 6256) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6256) |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-01 |