| NPI | 1730417148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3968) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 1385) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2015-02-18 |