| NPI | 1700298056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 2932) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00391) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-05-21 |