| NPI | 1750310157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 1732) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 27-1732) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-02-07 |