| NPI | 1700445210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6002) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OR 6002) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OR 6002) | |
| Enumeration Date | 2019-06-08 |
| Last Update Date | 2024-10-09 |